Book review: Yalom's memoir bravely turns the psychoanalytic gaze inwards

By Suntosh R. Pillay

When I read The Gift of Therapy after my internship, I felt liberated. I started my first year of independent practice with a newfound confidence and ease born directly from my first foray into the masterful, soulful, instructive storytelling of Dr. Irvin D. Yalom. I have, over the years, internalized his voice and drew consistent inspiration from his novels and textbooks to help me understand how to be an effective psychotherapist. So it was with exhilaration and anxiety that I began reading his final book, his autobiography written at age 85, Becoming myself: A psychiatrist’s memoir (Basic Books, 2017).

My trepidation to venture into the life story of a figure I have obviously idealized was like the kind of awkwardness felt at bumping into your own therapist or supervisor in the supermarket and seeing them in short pants and a torn T-shirt, buying toothpaste and toilet paper. Oh yeah, they’re human, too. Damn.

Indeed, Yalom does not disappoint in turning the analytic gaze inwards and being vulnerable, exploring his formative relationships and their impact on his personality, values, beliefs and worldview. The very first chapter, an eloquently written three pages, The Birth of Empathy, quickly sets the tone for the book. Here, Yalom remembers waking from a nightmare of an incident that really happened during childhood, in which he mocked a freckled young girl by shouting “Hey, Measles!” Horrified by his boyhood indifference to her feelings, he wakes up feeling ashamed. He poignantly ends this tale by pleading “Forgive me, Alice.”

Forgiveness does trickle through the book as one of several emotive themes and narrative threads that Yalom uses to make sense of his long life. He lays bare his intense anger towards both his parents, each with its own history. As a first-generation child of immigrants – Yiddish-speaking Russian Jews – he grew up in a gritty Washington D.C. neighbourhood. His parents owned a shop in which young Irv roughed it out, grappling with the tensions of trying to integrate into American life, and balance his parents’ orthodoxy with his own religious scepticism.

This question of the good life, and what it means to live with freedom and authenticity, also flows through the book. We see the early roots of his fascination with Western philosophers, leading to his pioneering textbook Existential Psychotherapy. He does not avoid confronting one of the core pillars of his own existential approach – death anxiety – as it pertains to his own mortality, legacy, admiration and refusal to retire (he still sees patients in San Francisco). Nor does he avoid admitting the inherent difficulties of writing a biography as an octogenarian and needing to fill the fuzzy gestalts with palatable fantasies:

I try to recapture parts of my own youth… I’m shocked at how differently we remember things [and] as I help patients reconstruct their early lives, I grow increasingly convinced of the fragile and ever-shifting nature of reality. Memoirs, no doubt this one as well, are far more fictional than we like to think (p.50).

The book is an easy, conversational read in forty chapters and 343 pages. The chapters vary from 3 page flashbacks, to 19 page history lessons, taking the form of chronological snapshots tracing his early life, his love for literature, meeting and marrying Marilyn (an accomplished scholar of French literature who made major early professional sacrifices that allowed Yalom’s career to flourish), seeing his first psychiatric patient in 1955, his mentors, his career at Stanford University, the many enviable sabbaticals in exotic locations wherein he usually wrote his books in picturesque tranquillity, and the motivations and expectations underlying his famous novels, such as Love’s Executioner, When Nietzsche Wept or The Spinoza Problem.

This book is useful for many audiences. This is a rare glimpse into the personal life of, arguably, our field’s most famous psychotherapist, a scholar-practitioner committed to creating curative relationships that were unusually genuine, interactive, transparent, and intimate. He also layers a fascinating, brief history of the development of psychotherapy more broadly – from the encounter groups of the 1960s to online therapies of 2017. He shares ‘behind-the-scenes’ insights into his writing process, his quirky but fruitful innovations – especially in group work – and his own, frequent encounters on the couch himself. He admits that he is “a novice at getting old” and now feels a sense of foreboding when audiences applaud him at conferences – “I have a disquieting sense they are saying farewell”.

There is little to be critiqued and a memoir is necessarily self-indulgent. At times the tone gets dry, repetitive, and more descriptive than reflective, but these lulls can be forgiven as he keeps a steady pace. He also remains oddly silent on the medical aspects of being a psychiatrist, but admits that medication was never his expertise or interest, and he preferred the humanities. ‘A psychotherapist’s memoir’ would have been a more apt subtitle for the book. For the critical reader, he avoids any detailed discussion of aspects of his privileged positionality and the temporal advantages of being a white, heterosexual, male doctor in the USA at the time, and the kinds of power and authority that was easily afforded to him, despite a torturous youth as “the only white kid in a black neighbourhood, the only Jew in a Christian world”.

Ultimately, this brave book does everything an excellent memoir out to do, and Yalom reveals enough of himself for us to understand the man behind the charm, and the history of an era.

Suntosh R. Pillay is a clinical psychologist at a public hospital in Durban. This review was first published in the May 2018 issue of South African Psychiatry.